CD 41: BALLOT HARVESTING

FOR STAFF USE ONLY

Staff Member Collecting

Name of Staff Member(Requerido)

Voter Information

Name of Voter(Requerido)
MM slash DD slash YYYY
Address of Voter(Requerido)

Ballot Collection

MM slash DD slash YYYY
Time of Ballot Collection(Requerido)
:
Name of Ballot Collector(Requerido)

Authorized Returner

Name of Authorized Returner(Requerido)
MM slash DD slash YYYY
Time of Delivery to ROV(Requerido)
: